Misconception: The Small Penis
Men in general have a distorted view of what’s normal for penile size. The fact is, "average" was not defined until recently. A study published in the September 1996 Journal of Urology concluded that average flaccid penile length was 8.8 cm (3 1/2 inches), and average erect length was 12.8 cm (5 inches). Also, according to many women’s magazine surveys, "size doesn’t matter." But many men remain fixated on the ideal of the 8- to 10-inch penis.
Some men don't even realize what they have. For example, obese men develop a suprapubic fat pad that conceals the penis, making it look shorter. Pressing firmly on this fatty tissue reveals the true penile length. I often explain this to patients, but a man who is convinced his penis is too small is hard to convince otherwise.

Occasionally a perception of inadequate penile length is a manifestation of underlying feelings of inadequacy in general. In these instances, psychological counseling may prove helpful.

When Surgery Is Warranted
Certain men suffering from urologic conditions may need plastic surgery on the penis: those with traumatic defects; those whose penises have retracted following a spinal cord injury; those born with a condition called epispadius (a severe penile deformity with associated shortening); and some men with Peyronie’s Disease (scarring of the penile shaft resulting in severe angulation and occasionally shortening). For these men, surgical procedures are available to give the penis additional length and a more normal appearance. However, these procedures, even in the best of hands, often result in wound infection or other healing complications. Sexual function may be impaired, and an artificial penile prosthesis may need to be inserted at the time of such surgery.

Enlargement Surgery: Still Experimental and Risky
Within the past 10 years, some surgeons have attempted purely cosmetic penile enlargement surgery on healthy men to enhance both length and girth of the penis. This surgery usually involves cutting the band of tissue that holds the penis up against the pubic bone (the suspensory ligament), and then injecting fat, harvested by liposuction, beneath the penile skin to add bulk. The surgery is still experimental: Two recent studies (one in 1994, the other in 1996) published in the Journal of Urology reported significant complications resulting from this surgery -- serious wound infections and penile deformity, such as lumpiness and asymmetry. In fact, the surgery is still so controversial and yields such poor results that it is considered generally unacceptable by both the plastic surgery and urological communities.

In addition, such procedures are expensive, costing up to $10,000 in some instances. Penile enlargement is not a simple undertaking and is usually not medically necessary. If you choose to pursue surgical enlargement, be sure to check the credentials of your surgeon (e.g., board certification) and carefully weigh the risks and potential benefits.

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